eMedicine Specialties > Urology > Hydronephrosis and Ureter Disorders
Hydronephrosis and Hydroureter: Treatment & Medication
Updated: Feb 25, 2008
- Overview
- Differential Diagnoses & Workup
- Treatment & Medication
- Follow-up
Treatment
Medical Care
The role of medical treatment of hydronephrosis and hydroureter is limited to pain control and treatment or prevention of infection. Most conditions require either minimally invasive or open surgical treatment. Two notable exceptions are (1) oral alkalinization therapy for uric acid stones and (2) steroid therapy for retroperitoneal fibrosis.2
Surgical Care
The specific treatment of a patient with hydronephrosis and hydroureter depends, of course, on the etiology of the process. Several factors help determine the urgency with which treatment should be initiated. In general, any signs of infection within the obstructed system warrant urgent intervention because infection with hydronephrosis may progress rapidly to sepsis. A mildly elevated white blood cell count is often observed in patients with stones but does not necessarily mandate immediate action in the absence of other signs or symptoms of systemic infection. However, even a low-grade fever in a diabetic or immunosuppressed patient (ie, on steroid therapy) requires immediate treatment.
The potential for loss of renal function also adds to the urgency (eg, hydronephrosis or hydroureter bilaterally or in a solitary kidney). Finally, patient symptoms help determine the urgency with which treatment is initiated. For example, refractory pain in a patient with an obstructing ureteral calculus necessitates intervention, as does intractable nausea and vomiting.
- Urethral catheterization is important to help rule out a lower tract cause for hydronephrosis and hydroureter. Difficulty in placing a Foley catheter may suggest urethral stricture or bladder neck contracture.
- Urologists commonly use ureteral stent placement in cases of intrinsic and extrinsic causes of hydronephrosis. The procedure is usually performed in conjunction with cystoscopy and retrograde pyelography. Stents can bypass an obstruction and dilate the ureter for subsequent endoscopic treatment.
- Urologists or interventional radiologists can place a percutaneous nephrostomy tube. Usually, ultrasonography is used first to locate the dilated collecting system. Using the Seldinger technique, a tube ranging from 8-12F can be placed. Nephrostomies are typically placed when a retrograde stent cannot be passed because of anatomic changes in the bladder or high-grade obstruction in the ureter. Because this procedure can be performed under local anesthesia, patients who are too hemodynamically unstable for general anesthesia may undergo percutaneous nephrostomy tube placement. In addition, nephrostomy tube placement may be performed with minimal use of radiation and may be useful in pregnant patients.
- Advances in endoscopic and percutaneous instrumentation have decreased the role of open or laparoscopic surgery for hydronephrosis. Certain causes of hydronephrosis, mostly extrinsic, still require treatment with open surgery. Examples include retroperitoneal fibrosis, retroperitoneal tumors, and aortic aneurysms. Some stones that cannot be treated endoscopically or with extracorporeal shockwave lithotripsy require open removal. Although endoscopic management does play a role in low-grade low-stage ureteral tumors, these lesions also usually require open or laparoscopic surgical management.
- Urine should be collected from the kidney when obstruction is relieved to allow identification and targeted treatment of any infection that may be present.
Consultations
Refer the patient to a urologist whenever hydronephrosis or hydroureter is newly diagnosed. Further consultations may be sought by the urologist, depending on the circumstances. For example, a nephrologist's input would be useful in cases of severe pathological postobstructive diuresis. Also, an interventional radiologist would be needed for nephrostomy tube placement if urgent decompression is needed and ureteral stent placement is not possible.
More on Hydronephrosis and Hydroureter |
| Overview: Hydronephrosis and Hydroureter |
| Differential Diagnoses & Workup: Hydronephrosis and Hydroureter |
Treatment & Medication: Hydronephrosis and Hydroureter |
| Follow-up: Hydronephrosis and Hydroureter |
| References |
| « Previous Page | Next Page » |
References
Chuang FR, Lee CH, Chen CS, Weng HH, Wang IK. Bilateral moderate hydroureteronephrosis due to uterine prolapse: two case reports and review of the literature. Ren Fail. Sep 2003;25(5):879-84. [Medline].
Smith SJ, Bosniak MA, Megibow AJ, Hulnick DH, Smiles S. CT demonstration of rapid improvement of retroperitoneal fibrosis in response to steroid therapy. Urol Radiol. 1986;8(2):104-7. [Medline].
Chen MY, Zagoria RJ, Dyer RB. Radiologic findings in acute urinary tract obstruction. J Emerg Med. May-Jun 1997;15(3):339-43. [Medline].
El-Ghoneimi A. Laparoscopic management of hydronephrosis in children. World J Urol. Dec 2004;22(6):415-7. [Medline].
Fielding JR, Fox LA, Heller H, Seltzer SE, Tempany CM, Silverman SG, et al. Spiral CT in the evaluation of flank pain: overall accuracy and feature analysis. J Comput Assist Tomogr. Jul-Aug 1997;21(4):635-8. [Medline].
Hsu TH, Streem SB, Nakada SY. Management of Upper Urinary Tract Obstruction. In: Kavoussi LR, Novick AC, Partin AW, Peters CA, Wein AJ, eds. Campbell-Walsh Urology. Vol 2. 9th ed. Philadelphia, Pa: Saunders Elsevier; 2007:1195-1226.
Pain VM, Strandhoy JW, Assimis, DG. Pathophysiology of urinary tract obstruction. In: Kavoussi LR, Novick AC, Partin AW, Peters CA, Wein AJ, eds. Campbell-Walsh Urology. Vol 2. 9th ed. Philadelphia, Pa: Saunders Elsevier; 2007:1227-73.
Shokeir AA, El-Diasty T, Eassa W, Mosbah A, Mohsen T, Mansour O, et al. Diagnosis of noncalcareous hydronephrosis: role of magnetic resonance urography and noncontrast computed tomography. Urology. Feb 2004;63(2):225-9. [Medline].
Singh V, Patel R, Pradhan P. Single umbilical artery and associated hydronephrosis: a report of 2 cases. J Reprod Med. Feb 2004;49(2):136-8. [Medline].
Smith RC, Verga M, McCarthy S, Rosenfield AT. Diagnosis of acute flank pain: value of unenhanced helical CT. AJR Am J Roentgenol. Jan 1996;166(1):97-101. [Medline].
Spencer JA, Chahal R, Kelly A, Taylor K, Eardley I, Lloyd SN. Evaluation of painful hydronephrosis in pregnancy: magnetic resonance urographic patterns in physiological dilatation versus calculous obstruction. J Urol. Jan 2004;171(1):256-60. [Medline].
Stoller ML, Gentle DL, McDonald MW, Reese JH, Tacker JR, Carroll PR, et al. Endoscopic management of upper tract urothelial tumors. Tech Urol. 1997;3(3):152-7. [Medline].
Watson G. Problems with double-J stents and nephrostomy tubes. J Endourol. Dec 1997;11(6):413-7. [Medline].
Ziedel ML, Pirtskhalaishvili G. Urinary tract obstruction. In: Brenner BM, ed. Brenner and Rector's The Kidney. 7th ed. Philadelphia, Pa: Elsevier Inc; 2004:1867-94.
Further Reading
Keywords
hydronephrosis, hydroureter, urinary tract obstruction, renal pelvis dilation, calyces dilation, hydroureteronephrosis, hydronephrotic system, pyonephrosis, urine flow interruption, interrupted urine flow, pyelolymphatic backflow, renal colic, advanced pelvic malignancy, prostatic hypertrophy, prostate cancer, cervical cancer, pregnancy, ureter calculi, ureteral calculi, ureteropelvic junction obstruction, UPJ obstruction, urine reflux, postobstructive diuresis
Treatment & Medication: Hydronephrosis and Hydroureter